A Republican Pound of Cure

On Respectful Insolence, Orac writes “the relationship between health insurance and, well, health is a question that can be addressed scientifically, which puts it right smack dab within the purview of science-based medicine.” Orac contradicts Mitt Romney’s statement that because a 1986 mandate requires hospitals to treat anyone needing emergency treatment, people don’t die for want of insurance. Orac writes, “Emergency rooms are not equipped to treat complex conditions; all they can do is to treat the acute problem.” And forced to eat expenses, private hospitals are liable to treat any patient who “failed a wallet biopsy” like a hot potato. Studies show that about 20,000 Americans die every year because they lack insurance. And they don’t do so cheaply. On Denialism Blog, Mark Hoofnagle notes “some 55% of emergency room care goes uncompensated” and those costs are often transferred to other patients. He calls this “one big stupid cost-shifting game that ignores the central problem.” Hoofnagle continues, “what is the point of stabilizing a patient with COPD and asthma as they come in the hospital in crisis every month, rather than just paying for their medications as an outpatient?” As they say, an ounce of prevention is worth a pound of cure.


Healthcare Survives Supreme Court

Chief Justice John Roberts proved himself an independent thinker last month, siding against his fellow conservatives (and Republican appointees) in upholding the Affordable Care Act of 2010. Roberts agreed that Congress could not force a citizen to buy insurance, but allowed the individual mandate to survive as a tax. In the meantime, the ruling placed limits on federal power to expand Medicaid, leaving 16 million people in the lurch. Liz Borkowski says “the Supreme Court’s decision clouds what should have been a clear distribution of the most beneficial impacts to the most needy.” Kim Krisberg heard the news at a meeting of the American Public Health Association, where Georges Benjamin said it “marks tremendous progress towards reshaping our health system into one that saves the lives of at least 44,000 people who die annually simply because they do not have health insurance.” On Denialism Blog, Mark Hoofnagle compares insurance systems around the world, and looks forward to more economical healthcare. He writes, “We can do it expensively, wastefully, and emergently in the ER, or we can do it like thoughtful, decent citizens who care about each other’s welfare.”

Cost, Cause & Effect

Cause and effect weave a tangled web, but a new data analysis tool called MIC can help make sense of it all.  The Weizmann Institute writes that “Large data sets with thousands of variables are increasingly common in fields as diverse as genomics, physics, political science, economics and more.”  Evaluating pairs of variables from among the thousands, MIC assigns each a score based on the strength of the relation between its variables.  For example, while combing through an incredibly complex dataset from the World Health Organization, MIC observed that “obesity increases monotonically with income in the Pacific Islands,” where girth is a sign of status.  MIC could also be used to build baseball rosters, Moneyball style.  Meanwhile, on Denialism Blog, Mark Hoofnagle explains why healthcare is so expensive in the United States.  Hospitals must treat all comers, so the uninsured are more likely to enter the most expensive point of care (the emergency room), at the most advanced stage of illness or injury, and end up incurring the highest bill.  Hoofnagle writes, “As a result, to pay for excessive care of the uninsured, all procedures, all tests, all imaging, and all hospitalizations cost more.”  Furthermore, healthcare providers are encouraged to order more tests and perform more procedures in order to maximize revenue and hedge their bets.

Endless Questions?

What’s better than an answer to a question? More questions, perhaps? ScienceBloggers have been very quizzical the last few days, beginning with Jason Rosenhouse on EvolutionBlog. After co-authoring Taking Sudoku Seriously with Laura Taalman, Rosenhouse wondered if 17 is really the minimum number of clues needed to solve a Sudoku puzzle. Although no one has ever generated a workable 16-clue puzzle, proof has been out of reach—until now?

On Starts With a Bang, Ethan Siegel considers the possibilities when a supernova remnant has nothing to show at its center. It could be the result of two colliding stars, exploding with nary a trace—or it could be that the former star accreted mass from a companion too small and dim to be seen.

Meanwhile, Dr. Dolittle gets intimate with blue-footed boobies on Life Lines, writing “repeated mating comes with diminished foot color and attractiveness as the males get older.” What’s a sapped old seabird to do? And Mark Hoofnagle gets serious on denialism blog, asking “How do you want to die?” Maximal intervention, which can involve “placing central lines, keeping him on a ventilator, catheterizing the bladder, placing rectal tubes, total parenteral nutrition, and pursuing aggressive therapies” may not always be the best choice for end-of-life care. Hoofnagle writes, “Doctors typically forgo extreme measures in the face of terminal diagnoses, and often reject the type of care we routinely provide to our patients. […] It used to be the doctor wouldn’t ofter the choice if he or she felt it was futile, now patients are given choices, endless choices.” Sometimes a simple answer is in order.

Imagining the Future

i-623d2553395dea8ccb96564bd63b94dc-futurebuzz.jpgOn Universe, Claire L. Evans interviews sci-fi world-builder Ursula K. Le Guin. Their conversation centers on the Google Books Settlement, which seeks to “circumvent existing U.S. copyright law.” While Le Guin hopes her books will become more accessible in the future, she says “the vast and currently chaotic electronic expansion of publishing should not be controlled solely by corporations.” On Uncertain Principles, Chad Orzel reviews China Mieville’s new novel The City and the City, which is about two cities that enforce very strict boundaries despite being “co-located” on the same real estate. While Chad appreciates the trickiness of the premise and Mieville’s “bravura show of writing ability,” he wonders why either city “would agree to such a daft state of affairs.” On Pharyngula, PZ Myers gripes about SF’s dependence on humanoid aliens, asking why more creators don’t examine “the diversity within the phylum Chordata, let alone some of the weirdness in other phyla.” And on Collective Imagination Greg Laden wonders if having a chip in his head might make his medical odyssey a bit more efficient.

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A Booster Shot of Science

i-61ed3ad69ecf7bcac49952a599f3d645-vaccbuzz.jpgVaccines have guarded health and life for centuries, relegating once devastating diseases to near total obscurity. But many people now take vaccines for granted, and some blame vaccines for autism and other disorders. On Respectful Insolence, Orac reports the downfall of 1998 research which first tied MMR vaccines to the occurrence of autism in children. As Orac writes, “hearing that the man whose bad science launched a thousand quackeries had finally been declared unethical and dishonest […] brought joy to my heart, the joy that comes with seeing justice done.” ERV jumps on other news, concerned that it could fuel anti-vaccine alarmism. Researchers inspecting animal vaccines discovered an infectious endogenous retrovirus originating from the cat cell lines used in vaccine production. This “distinct-from-but-related-to feline leukemia virus” raises concerns about vaccines passing ERVs from one species to another. Finally, Janet Stemwedel on Adventures in Ethics in Science vents some steam after reading student attitudes toward H1N1 vaccination in the school newspaper. Janet criticizes both the newspaper for juxtaposing “reliable information from experts with whatever a student wandering across the reporter’s path might happen to opine,” and the students themselves for holding forth their unscientific optimism.

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A Prescription for Alternative Medicine?

i-4d5c4663e54e0d912350b44b8b91c423-altbuzz.jpgLast month, lawmakers in Ontario, Canada introduced legislation that would award prescription rights to graduates of two naturopathic schools. Should students subject to different educational standards be granted the same powers of prescription? On Terra Sigillata, Abel Pharmboy calls it inconsistent for the naturopathic community to “want the right to prescribe regulated medicines while simultaneously decrying medicine and science-based investigative methods,” adding that “homeopathy is diametrically opposed to dose-response pharmacology.” You can learn more about homeopathy here. Then visit The White Coat Underground, where PalMD agrees with the skeptical maxim that there is “no ‘alternative’ to medicine; only that which is proven to work, and that which is not.” PalMD goes on to write that alternative medicine tends to inspire “oversimplification and naive, hyperbolic conclusions.” And finally, Greg Laden on his blog recounts the time when his friend slipped into a coma, bringing months of homeopathic floundering to a simple surgical conclusion.

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